Suboxone (buprenorphine with naloxone) and methadone are the two most widely used medications for opioid use disorder. Both work. Both lower the risk of dying from an overdose and make it more likely that someone stays in treatment, according to NIDA and its research report. The biggest differences are practical: where you get the medicine, how often you have to show up, and how strong its effect is.
The short version
| Suboxone (buprenorphine) | Methadone | |
|---|---|---|
| How it works | Partial opioid agonist: activates opioid receptors part way, with a "ceiling" on its effect | Full opioid agonist: activates receptors fully, long-acting |
| Where you get it | Any doctor, nurse practitioner or PA allowed to prescribe controlled medications; picked up at a pharmacy | Only at a federally certified opioid treatment program (methadone clinic) |
| How often you go in | Usually weekly to monthly visits once you're stable | Often daily at first, with take-home doses earned over time |
| Starting it | You usually need to be in early withdrawal first | Can start without being in withdrawal |
| Best fit | People who want treatment that fits around work and family | People with heavy or long-term use, or who didn't do well on buprenorphine |
How each medication works
Methadone is a long-acting full opioid agonist. It fills the same receptors that heroin, fentanyl and pain pills act on, but slowly and steadily, so it stops withdrawal and cravings without the highs and crashes. It has been used to treat opioid addiction since the 1960s and has the longest research record of any option.
Buprenorphine, the main ingredient in Suboxone, is a partial agonist. It binds to the same receptors very tightly but only switches them on part way. That "ceiling effect" means taking more doesn't keep increasing its effect, which lowers the risk of overdose from the medication itself. Suboxone adds naloxone, which does nothing when the film or tablet is taken under the tongue as directed but makes misuse by injection unpleasant.
Where you can get each one
This is often the deciding factor.
Methadone for opioid addiction can only be dispensed by a federally certified opioid treatment program, often called a methadone clinic. Across the 15 states currently listed on this site, we list 897 programs that are certified opioid treatment programs or that offer methadone. That includes 38 in New Jersey and 75 in Florida.
Buprenorphine is far easier to find. Since early 2023, any clinician with a standard DEA registration for controlled medications can prescribe it for opioid use disorder; the old special "X-waiver" is gone (SAMHSA). You fill the prescription at a regular pharmacy. Many programs also prescribe it through telehealth.
You can search both on our state directory and filter each city's list by "Methadone clinic" or "Buprenorphine (Suboxone)".
What starting treatment looks like
Starting Suboxone. Because buprenorphine binds so tightly, taking it while full opioids are still active can push them off the receptors and cause sudden, intense withdrawal ("precipitated withdrawal"). So prescribers usually ask you to wait until you're in mild to moderate withdrawal before the first dose. Fentanyl can make this timing trickier because it lingers in the body; prescribers now use several approaches to make the switch easier, so tell them honestly what you've been using.
Starting methadone. You go to the clinic, meet with a medical provider, and get your first dose there. The dose is raised slowly over days to weeks, because methadone builds up in the body. Most people go to the clinic daily at first. Federal rules updated in 2024 give clinics more room to allow take-home doses earlier for patients who are stable.
Side effects and safety
Both medications can cause constipation, sweating, sleepiness and other opioid-like side effects, especially early on.
- Methadone carries more overdose risk early in treatment and when mixed with alcohol, benzodiazepines or other sedatives. It can also affect heart rhythm in some people, so clinics may check an ECG.
- Buprenorphine's ceiling effect makes it safer on its own, but it is still dangerous when combined with alcohol, benzodiazepines or other sedatives.
Never change your dose on your own. Doses are set and adjusted by the prescriber or clinic.
Cost and insurance
Medicaid in every state covers medications for opioid use disorder, including methadone and buprenorphine, under a federal requirement in place since October 2020 (CMS). Medicare covers both as well, including methadone at opioid treatment programs. Most private insurance plans cover buprenorphine, though some require prior authorization. Each listing on our pages shows the insurance and payment the program reports accepting.
Which one is right for you?
There's no single right answer. Some general patterns:
- Buprenorphine often fits people who want to keep working, who live far from a methadone clinic, or who want fewer in-person visits.
- Methadone often fits people with long or heavy use, people who tried buprenorphine and kept having cravings, and people who benefit from the daily structure and counseling at a clinic.
- People can switch. Moving from one to the other is common and can be done safely with a provider's help.
Naltrexone (Vivitrol) is a third option. It's not an opioid at all, but you must be fully off opioids for days before starting it, which is hard for many people.
Getting help
To compare programs near you, start with your state page. If you'd like help sorting through options or checking what your insurance covers, call (844) 690-1589 to talk with an admissions counselor at TOS, any time.
You can also call the free, confidential SAMHSA National Helpline at 1-800-662-4357. If you or someone you love is in crisis, call or text 988.